Impact of Symptom Duration on Baseline Characteristics of the Multidisciplinary Approach to Pelvic Pain (MAPP) Study Cohort

Rodriguez LV, Stephens A, Clemens JQ, Buchwald D, Yang C, Lai HH, Krieger J, Bradley CS. Impact of Symptom Duration on Baseline Characteristics of the Multidisciplinary Approach to Pelvic Pain (MAPP) Study Cohort. Paper presented at: American Urological Association Annual Meeting; 2013 May 7; San Diego, CA.

Introduction and Objectives Symptom severity in patients with urologic chronic pelvic pain syndromes (UCPPS), has been associated with symptom duration. Compared with the general population, UCPPS patients have higher rates of other somatic syndromes, such as fibromyalgia (FM), irritable bowel syndrome (IBS) and chronic fatigue syndrome (CFS), and mental health comorbidities. We hypothesized that UCPPS patients with longer duration of symptoms would also be more likely to report these comorbid conditions. We evaluated cross-sectional associations between symptom duration and 1) symptom severity, and 2) presence of other somatic syndromes and mental health symptoms. Methods Baseline data were analyzed from the MAPP Epidemiology and Phenotyping Study, a NIH-sponsored multi-center observational study of patients with UCPPS. Patients were stratified by symptom duration as a discrete ( < or > = 2 years) or continuous variable. Symptom severity was assessed by the Genitourinary Pain Index (GUPI), the IC Symptom and Problem Index, and Likert scales for pelvic pain, urgency and frequency. Depression and anxiety were evaluated with the Hospital Anxiety and Depression Scale (HADS) and stress with the Perceived Stress Scale (PSS). Results 442 participants were included. Males (not females) with symptoms > = 2 years had more severe symptoms than those with < 2 years (p < 0.05). When evaluating symptom duration as a continuous variable, adjusting for age and gender, there was an increase in GUPI total and GUPI pain subscale scores for each additional year of symptoms (p < 0.01). Females were 62% more likely than males to have other somatic syndromes (p < 0.03). On multivariable analysis, there was a significant increase in the likelihood of patients experiencing CFS (1.043/yr) and FM (1.041/yr), but not IBS for each additional year of UCPPS symptoms (p < 0.015). Conclusions Females with UCPPS symptoms < 2 years experienced more severe urinary symptoms, higher levels of stress, anxiety and depression than males with symptoms < 2 years. Symptom duration was associated with increased severity of urinary symptoms and risk for concomitant somatic disorders. These findings point to gender-specific differences in the likelihood of comorbid conditions and symptom severity in UCPPS patients with longer symptom duration.